Beat it

Beat it

New found hormone holds hope for diabetes treatment

The new research suggests that giving diabetics a hormone might help them avoid insulin shots.
Harvard Stem Cell Institute Co-Director Doug Melton, right, and Peng Yi, a post-doctoral fellow in his lab, review data April 5 in Melton's lab in Cambridge, Mass. Melton and Yi have identified a hormone that can sharply boost a mouse's supply of cells that make insulin, a discovery that may someday provide a diabetes treatment.(Photo: Harvard University via AP)
A newly discovered mouse hormone may open the door to better treatment for diabetes, researchers suggested Thursday.
The hormone, called betatrophin, triggers the growth of pancreatic "beta" cells lost or ineffective in diabetes. Insulin is produced by beta cells in the pancreas.
Diabetes afflicts more than 25 million people nationwide, according to the American Diabetes Association. It is a condition that causes high blood sugar that can lead to heart disease, kidney failure and blindness.
In the journal Cell, a team led by Harvard's Peng Yi reports that betatrophin can produce a roughly seventeenfold increase in these cells, and its increase may partly explain the rapid growth of these cells seen during pregnancy to feed developing fetuses in mammals, including people.
"This is really an amazing discovery. Hormones with this kind of effect aren't discovered very often, and this opens a whole new pathway to treating diabetes," says diabetes expert Jake Kushner of the McNair Medical Institute at Baylor College of Medicine in Houston, who was not part of the study team. He cautioned that the hormone's effects, which the study team sees as isolated to beta cells, need to be thoroughly investigated in animal studies for safety.
The hormone was discovered almost by accident, as the Harvard team investigated a research compound that basically recreates what happens in diabetes. The compound short circuits the release of insulin in response to increasing blood sugar. When that happened to the mice in the study, their production of the hormone betatrophin ramped up and spurred the growth of insulin producing cells. Diabetics often need daily insulin injections to compensate for the condition, where in Type 2, or adult-onset diabetes, the most frequent kind, beta cells stop producing enough insulin, and in juvenile diabetes, or Type 1, about 10% of cases, beta cells have died.
"Of course, we are a long way from a treatment. But if this could be used in people, what I think it could mean eventually is that instead of taking insulin injections three times a day, you might take an injection of this hormone once a week or once a month," says study senior author Doug Melton of the Harvard Stem Cell Institute, in a commentary provided by the university.
Melton is best known as a prominent human stem cell researcher, whose own children suffer from juvenile diabetes; he has previously done pioneering research on how beta cells grow during development.
In the study, the team reports that young mice given the hormone grew just enough new beta cells to counteract the drug's effects, no more.
"Before it can be established if this finding has any relevance to human therapy it will need to be established (that) the molecule drives beta cell replication in humans," says beta cell expert Peter Butler of the University of California, Los Angeles, by e-mail. He cautions that "a variety" of compounds have earlier been identified that drive beta cell growth in young mice but these have then not had the same effect on beta cells in people.
The study researchers acknowledge they don't know exactly how the hormone spurs the growth of beta cells, whether directly or by triggering a cascade of activity that leads to more of them. The researchers have entered into agreement with two pharmaceutical firms, Evatec and Jansen, to investigate treatments with the hormone. The study was largely funded by research money from the 2009 federal stimulus, Melton says.
Despite his enthusiasm, Kushner also cautioned that if the hormone proves less effective in older mice, that would limit its appeal for use in adult-onset diabetics, who usually develop the disease in their 50s. And if the hormone grows beta cells by causing existing ones to divide and grow directly, it might be less useful for juvenile diabetes, where beta cells have largely been wiped out. "It is a nice example of basic researchers working with pharmaceutical research, a drug that causes insulin resistance, to uncover something fundamental to biology that might help people," he says.

Diabetes Research Focuses Heavily On Treatments, Not Prevention, Study Finds

When it comes to researching diabetes, are our priorities in order?
According to a Duke University study, diabetes research emphasizes drug therapies more than preventive measures to combat the disease. The current research also tends to leave out older adults and children, who could benefit substantially from better disease management.
The findings, published in the journal Diabetologia, suggest that current research efforts may not sufficiently study diabetes prevention, management or therapeutic safety.

The authors of the study examined nearly 2,500 diabetes-related trials from 2007 to 2010. They found that of the 2,484 trials correlated with diabetes, 75 percent emphasized diabetes treatment while only 10 percent were conducted to examine preventive measures. Sixty-three percent of the trials involved a drug and 12 percent involved behavioral tests.
“It’s important that clinical trials enroll patients who are representative of populations affected by diabetes and its complications,” study researcher Dr. Jennifer Green, M.D, an associate professor at Duke University School of Medicine and a member of the Duke Clinical Research Institute, explained in a statement. “Our study is just a snapshot in time, but it can serve as a guide for where we need to focus attention and resources.”
The study also found that most clinical trials assessed small numbers of patients in a constrained number of locations. Many trials took only two years to complete and did not seem to exhibit a geographical mix of diabetes patients.
Type 2 diabetes risk is highest for adults and seniors, but the rate of the condition among kids and teens is also increasing. Yet the study found that older people were not included in 31 percent of the trials. In fact, older individuals were only the core of 1 percent of the trials. Furthermore, only 4 percent of the trials focused on diabetes in people age 18 and younger.
Green believes that excluding certain individuals from these trials means that the research can’t necessarily apply to them. “We really don’t understand how best to manage disease in these patients –- particularly among patients of advanced age," she said in the statement. "So the exclusion of them from most studies and the small number of trials that specifically enroll older individuals is problematic.”
The findings apply to the 25.8 million adults and children -- more than 8 percent of the U.S. population -- who are currently living with diabetes

Diabetes – the silent assassin

Diabetes is not a curable disease, but it is largely preventable or manageable with a healthy lifestyle,
Despite consuming chocolate in what I felt was moderation, by Easter Monday I was left with what I refer to as a sugar hangover. This is no medical phenomenon, but the name I give that irritability and lack of energy that follows post sugar binge.
Sugar is the energy source of the body; we do need it to survive, but how we control that energy source and release is also key to our long-term health and well-being.
Carbohydrates get broken down to glucose in the body, so all starchy foods such as bread, potatoes, and rice, along with crisps, sweets, biscuits, and cakes, ultimately become a source of sugar.
In order to provide energy, glucose has to enter the cells in our bodies. Insulin is a hormone that acts like a key to these cells. Whenever blood sugar rises insulin is released, then sugar enters the cells and is used as energy.
Certain foods such as vegetables, brown bread, rice, and pasta release sugar slowly, these types of food lead to more steady sugar levels. Sugars such as white carbohydrates and sweets, crisps, etc, cause a quick sugar rise, placing higher demands on Insulin in the body.
Over time, a diet high in these foods can increase the chance of the body become more resistant to, or becoming depleted in, insulin. This results in diabetes. There are two main types of diabetes; Type 1 (previously called insulin dependent) and Type 2 (previously called non-insulin dependent).
In Type 1 diabetes the body is unable to produce insulin. This accounts for about 10pc of cases of diabetes. It is an autoimmune condition, and usually starts in childhood or adolescence.
The exact cause is unknown but the result is that the cells that normally produce insulin are destroyed and unable to function.
People diagnosed with Type 1 diabetes need lifelong insulin injections to survive.
It is estimated that just under 200,000 people in Ireland have Type 2 diabetes, 30,000 of which are undiagnosed. A simple blood sugar test can help pick this up early, before symptoms appear.
In Type 2 diabetes, the body becomes resistant to the effects of insulin or does not produce enough. The symptoms of Type 2 diabetes include thirst, frequent urination, weight loss, and fatigue, however, they may come on gradually, or in some cases the symptoms are not obvious at all.
Blood glucose screening in those at risk can help diagnose the condition early. Type 2 diabetes is treated by diet, lifestyle modification, and medications that increase the body's sensitivity to insulin.
In some cases this is not enough, and some people do ultimately end up requiring insulin therapy. You are at risk of Type 2 diabetes if you have a family history of it, if you are obese (80pc of Type 2 diabetics are), if you lead a sedentary lifestyle, or if you are aged over 40.
So why do we care about sugar levels rising? Well when blood glucose levels are high they can damage virtually every cell in the body. The risk of heart and vascular disease doubles in the first five years after diagnosis.
High blood pressure is common in diabetics. It can also lead to kidney failure, nerve damage, erectile difficulties, eye damage, and foot and limb damage that may result in amputations. Diabetics therefore require regular check-ups to help catch any complications early, and to prevent further problems down the road.
The good news is that a healthy lifestyle can help reduce the risk of developing diabetes, so maintaining a healthy weight and diet and getting at least 30 minutes of exercise daily is really beneficial.
Even in those with the condition, if blood glucose levels are monitored and maintained at normal levels through lifestyle and medication then the risk of complications is greatly reduced.
Most people are under the impression that diabetics have to follow a special diet – the truth is there is no such thing.
It simply means eating plenty fruits, vegetables, and whole-grains, and controlling the amount of carbohydrate consumed; a diet we should all follow.
Portion control is also important: one or two small potatoes is okay, five or six is not! In those who are obese, weight loss is an essential part of management.
Diabetes is not a curable disease, but if you lead a healthy lifestyle throughout your life it is largely preventable or manageable.
We are all familiar with checking the sugar content in foods, but when did you last check the sugar in your blood?
Think about it. It might just save your life.

Arsenic exposure linked to diabetes

For the first time scientists have established a link between arsenic exposure in youngsters and development of Type 2 diabetes.
A new study found that higher levels of mercury exposure in young adults increased their risks for Type 2 diabetes later in life by 65 per cent.
The study, led by Indiana University School of Public Health-Bloomington epidemiologist Ka He, is the first to establish the link between mercury and diabetes in humans.
The study paints a complicated nutritional picture because the main source of mercury in humans comes from the consumption of fish and shellfish, nearly all of which contain traces of mercury, reports Science Daily.
Fish and shellfish also contain protein and other nutrients, such as magnesium and omega-3 poly-unsaturated fatty acids, that make them important for a healthy diet.
In the study, published online early in the journal Diabetes Care, the people with the highest levels of mercury also appeared to have healthier lifestyles -- lower body mass indexes and smaller waist circumferences -- than others.
They also ate more fish, which is a possible marker of healthy diet or higher social economic status. Risk factors for Type 2 diabetes include being overweight.
According to He, these findings point to the importance of selecting fish known to have low levels of mercury such as shrimp, salmon and catfish, and avoiding fish with higher levels such as swordfish and shark.
"It is likely that the overall health impact of fish consumption may reflect the interactions of nutrients and contaminants in fish. Thus, studying any of these nutrients and contaminants such as mercury should consider confounding from other components in fish," He and the authors wrote in the study.
"In the current study, the association between mercury exposure and diabetes incidence was substantially strengthened after controlling for intake of LCN-3PUFAs (omega-3) and magnesium," the study noted. 

Lose weight the CUBAN way: Economic crisis triggered an average weight loss of 11lb and slashed the risk of heart disease and diabetes

A country where economic crisis led to food and fuel shortages saw the average citizen lose 11lb and death rates from heart disease and diabetes fall considerably.
Researchers have studied the weight loss of people in Cuba, where the collapse of the Soviet Union sparked a reduction in eating and large increases in physical activity.
This resulted in an average weight loss of between 8-11lb - slashing deaths from heart disease by a third and halve deaths from type 2 diabetes, Spanish researchers have found.
Professor Manuel Franco, of the University of Alcala, Madrid, said: 'We found a population-wide loss of 4-5 kg in weight in a relatively healthy population was accompanied by diabetes mortality falling by half and mortality from coronary heart disease falling by a third.'
Cubans lost an average of 8lb per head over five years, after the country was plunged into crisis in the early 1990s following the collapse of the Soviet Union
The study, published online in the British Medical Journal, showed the benefits were seen in a relatively short period of time.
Heart disease is Britain's number one killer, with 94,000 people a year dying from it and 2.6 million living with it. About 75,000 people with diabetes die annually, accounting for about 15 per cent of all deaths.
The international team of researchers from Spain, Cuba and the U.S. said comparing disease rates over time can demonstrate the power of prevention and help identify key risk factors.
The researchers examined the association between population-wide body changes and diabetes incidence, prevalence and death rates from type 2 diabetes and cardiovascular disease, cancer and all causes in Cuba between 1980 and 2010.
The country has a long tradition of public health and heart disease research, which provided the necessary data from national health surveys, cardiovascular studies, primary care chronic disease registries and vital statistics over three decades.
Four population-based surveys were used and data were available on height, weight, energy intake, smoking and physical activity. All participants were aged between 15 and 74.
Population-wide changes in energy intake and physical activity were accompanied by large changes in body weight.
Between 1991 and 1995, there was an average 8lb (5kg) reduction, whereas between 1995 and 2010 a population-wide weight 'rebound' of 19lb (9kg) was observed.
Smoking prevalence slowly decreased during the 1980s and 1990s and declined more rapidly in the 2000s.
The number of cigarettes consumed per capita decreased during and shortly after the crisis, while diabetes prevalence surged from 1997 onwards as the population began to gain weight.
New cases decreased during the weight loss period but then increased until it peaked in the weight regain years.
In 1996, five years after the start of the weight loss period, there was an abrupt downward trend in death from diabetes.
As the economy slowly recovered, food intake increased and physical activity levels were reduced. In 2002, death rates returned to pre-crisis trends, diabetes deaths soared
This lasted six years during which energy intake gradually recovered and physical activity levels were reduced. In 2002, death rates returned to pre-crisis trends and a dramatic increase in diabetes death was observed.
Regarding heart disease and stroke death trends, there was a slow decline from 1980 to 1996 followed by a dramatic decline after the weight loss phase. These descending trends have halted during the weight regain phase.
Professor Franco said population science can give us the tools to combat diseases such as heart disease and diabetes and tackling unhealthy diet and physical inactivity can reduce the disease burden.
He also stressed the importance of promoting physical activity, including cycling and walking, as a means of transportation.
He added: 'So far, no country or regional population has successfully reduced the distribution of body mass index or reduced the prevalence of obesity through public health campaigns or targeted treatment programmes.'

Diabetes screening tests made easier

Canadian doctors have another option when screening people for Type 2 diabetes.
On Monday, the Canadian Diabetes Association unveiled its 2013 Clinical Practice Guidelines to prevent and manage diabetes. It's estimated a third of Canadians will have either diabetes or prediabetes by 2020.
The group hopes that a new standardized blood test, called the A1C, will encourage everyone over the age of 50 to get screened once every three years. The single measurement considers average blood glucoses levels over about three months.
The A1C does not require people to stop eating for 12 hours before taking the test as was the case previously. The test can also diagnose prediabetes before full-blown diabetes occurs.
"Pre-diabetes I like to think of as the waiting room to diabetes," said guideline chair and Toronto endocrinologist Dr. Alice Cheng. "We want to be able to identify who is sitting in that waiting and get them out of there as much as we can."
Through lifestyle interventions such as diet changes, exercise, losing weight, quitting smoking and self management of blood glucose levels, the group aims to prevent people with prediabetes from worsening. In some cases, blood sugar- and cholesterol-lowering drugs will also be prescribed.
Diabetes and Cardiovascular Disease ABCDEs
Heart disease is a major cause of death and disability for people living with diabetes. The new guidelines encourage them to know their heart health ABCDEs and work to educate healthcare teams to address them:
•           A – A1C (a measure of average blood glucose) in optimal range.
•           B – Blood pressure optimally controlled.
•           C – Cholesterol in target range.
•           D – Drugs - heart-protecting medications for the right patients.
•           E – Exercise and other lifestyle measures.
•           S – Stop smoking.
Overall, the group's message for health care professionals was to screen wisely and diagnose precisely since doctors can't treat what they don't know.
However, British epidemiologists have questioned whether screening more people saves more lives.
When Dr. Simon Griffin of the Addenbrooke Hospital in Cambridge compared mortality over 10 years in the United Kingdom, he found screening for Type 2 was not associated with a reduction in deaths from all causes, cardiovascular or diabetes.
"The benefits of screening might be smaller than expected and restricted to individuals with detectable disease," Griffin concluded in the October edition of the medical journal The Lancet.
Screening those with risk factors makes more sense than testing everyone over the age of 40, he said in an interview, adding that since diabetes tests have few risks there is little harm beyond questions of the best use of public health dollars.
"The problem of course with this prediabetes label is it actually labels people and has them living with a lifelong concern about their diabetes when in fact they might have perfectly normal blood sugar levels, they may be otherwise perfectly healthy people," agreed drug policy research Alan Cassels of the University of Victoria.
The ultimate goal of the guidelines is to avoid serious complications from diabetes such as kidney disease, heart attacks and strokes.
The guidelines were published in the Canadian Journal of Diabetes and on the Canadian Diabetes Association's website with interactive tools and resources for health care providers and people living with diabetes.

New Diabetes Drug Expected This Week

April 11, 2013 -- A new oral diabetes drug is expected to arrive on pharmacy shelves in the U.S. this week.
Many people predict that Invokana (canagliflozin), approved by the FDA in March, will be a brisk seller. That's partly because it treats type 2 diabetes in a new way.
It’s also because Invokana not only helped patients improve blood sugar control, but also lose weight and control their high blood pressure, according to maker Janssen Pharmaceutical Companies.
Losing weight can help people control their diabetes.
In one 26-week study, those on Invokana lost about 6 to 8 pounds, while those in the placebo group lost only about a pound.
But the drug has side effects, including infections of the urinary tract, penis, and vagina. This leads some experts to have less enthusiasm for the new medicine.
It will also cost a lot more than other diabetes drugs. The wholesale cost for Invokana is $8.77 a pill, according to Katie Mahony, a spokeswoman for Janssen. Retail cost for the 100-milligram starting dose, without co-pays or coverage, is about $10 a pill, or $300 a month.
The popular diabetes drug metformin can cost as little as 25 cents a pill.
"It's another way to control diabetes without injections," says Anthony McCall, MD. He is the James M. Moss Professor of Medicine at the University of Virginia School of Medicine in Charlottesville. He was not involved in the development of the new drug.
A new pill is welcome, McCall says, for some of the estimated 24 million Americans with type 2 diabetes, especially as an alternative to injecting insulin.
"People do have strong feelings about injectable medications," he says. However, he and other experts say they don't expect Invokana to replace other drugs, but rather to offer another option.
How Invokana Works
In type 2 diabetes, the body doesn’t make enough insulin or doesn't use it properly. As a result, blood sugar (glucose) levels rise, leading to complications such as heart disease, kidney damage, and nerve problems.
Invokana works by blocking glucose from being reabsorbed by the kidneys. That raises the amount of glucose urinated, and lowers the amount of glucose in your blood.
The new drug is known as a selective sodium glucose co-transporter inhibitor, or SGLT2. Other drug companies are also working on this type of drug.
Other diabetes drugs work in differently. Some lower the amount of glucose made by the liver, while others stimulate the pancreas to release more insulin. And still many others work in different ways.
While Invokana isn't expected to replace other diabetes drugs, ''it's certainly promising," says Aaron Cypess, MD, PhD, of the Joslin Diabetes Center and an assistant professor of medicine at Harvard Medical School. "It's a mechanism we understand and that makes sense."

Diabetes 'Cure' After Weight Loss Surgery Lasts Long Term

•           Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

•           This retrospective study suggests that bariatric surgery can induce significant long-term remission in type 2 diabetes.

Bariatric surgery may keep type 2 diabetes at bay for good, researchers found.
In a single-center study, 50% of patients whose diabetes resolved following bariatric surgery still had complete or partial remission of the disease about 6 years later, Stacy Brethauer, MD, of the Cleveland Clinic, and colleagues reported at the American Surgical Association meeting in Indianapolis.
Of those who had a complete remission, 27% met the definition of a "functional cure" of diabetes, defined by the American Diabetes Association (ADA) as a glycated hemoglobin (HbA1c) under 6% and a fasting blood glucose under 100 mg/dL that lasts longer than 5 years, Brethauer told MedPage Today.
For their study, Brethauer and colleagues assessed 217 patients with type 2 diabetes who underwent bariatric surgery at the Cleveland Clinic between 2004 and 2007. They were followed for a median of 6 years, with a range of 5 to 9 years.
The majority had gastric bypass surgery, but some patients also had gastric banding or sleeve gastrectomy.
Brethauer and colleagues found that remission -- including both partial and complete remission -- occurred in 50% of patients.
Complete remission was defined as an A1c below 6% and a fasting blood glucose under 100 mg/dL for at least a year without any medications, and 24% of patients hit this target.
Partial remission was defined as an HbA1c between 6% and 6.4% and a fasting blood glucose between 100 and 125 mg/dL for at least a full year without anti-diabetic drugs, and 26% of patients hit this target.
Brethauer noted that 27% of those who achieved a complete remission maintained it longer than 5 years, which qualified them for the ADA definition of a functional cure.
The effects were most pronounced for patients who'd had gastric bypass -- although Brethauer cautioned that selection bias could be at work because the trial was not randomized.
Still, after controlling for procedure in a multivariate analysis, bypass remained a significant predictor of long-term remission compared with the two other procedures, he said. Other predictors included a shorter duration of type 2 diabetes and greater weight loss.
Even though they didn't meet the criteria for continued remission, another 34% of patients still had significant improvements in glycemic control 6 years later.
"A large population was still well controlled," Brethauer told MedPage Today. "Many still met the ADA criteria [for being well controlled], even though we characterized them as recurrent diabetics."
Just 16% of patients had glycemic control that was unchanged from or worse than baseline in the long run, he added.
Brethauer and colleagues also looked at a subgroup of patients who had laboratory data on urinary albumin to assess diabetic nephropathy. Among those 59 patients, 40 had normal albuminuria at baseline and only 2 went on to develop protein in the urine. The other 19 started out with albuminuria, and 53% of them had regression while 47% remained stable.
"That's markedly different from what you'd expect, which is 2% to 4% progression to diabetic nephropathy [per year] in this patient population," he said.
Bariatric surgery is not currently indicated as a treatment for type 2 diabetes; the disease is a comorbidity that makes patients at the lower range of obese -- with a body mass index (BMI) of 35 to 40 -- qualify for bariatric surgery.
Only patients with a BMI of 40 or above qualify for the surgery on the basis of weight alone.
However, some organizations, including the International Diabetes Federation, have been pushing for bariatric surgery to be indicated for type 2 diabetes patients with a BMI of 30 to 35.
Indeed, recent guidelines from the American Association of Clinical Endocrinologists, The Obesity Society, and the American Society for Bariatric and Metabolic Surgery also concluded that these patients may be offered bariatric surgery -- with the caveat that the evidence is still limited.
"We feel that the benefits outweigh the risks for the majority of patients, but I think at this point many still consider it investigational," Brethauer said.

Mexicans eating themselves to death

MEXICO has long been a country that derives extraordinary pleasure from eating and drinking—and it hasn’t minded the consequences much either. Gordo or gorda, meaning “chubby”, is used by both wives and husbands as a term of endearment. Pudgy kids bear proudly the nickname gordito, as they tuck into snacks after school slathered with beans, cheese, cream and salsa.
Your correspondent, having just arrived to live in Mexico City after more than a decade away, finds the increase in waistlines even more staggering than the increase in traffic. Mexico has become one of the most overweight countries on earth, even more so than the United States; a quarter of its men and a third of its women are obese. Indecorously, the country has even come up with figures on figures: the Mexican Diabetes Federation says that among women between 20 and 49, the average waistline is 91.1cm (35.9 inches), more than 10cm above the “ideal” size. Stores are now full of large- and extra large-sized clothing.
Time was, a prominent girth may have been enviable proof of relative prosperity. Now, it is a serious health risk. At a conference here on April 9th it was estimated that more than 10m Mexicans, or almost a sixth of the adult population, suffer from diabetes, largely because of over-eating and increasingly sedentary lifestyles. Mexico has the sixth most cases of diabetes in the world.
Diabetes is one of the top two causes of death in the country, alongside (and occasionally overlapping with) heart disease. The diabetes federation says that the illness kills 70,000 people a year. However, it gets far less attention than much less deadly diseases such as HIV/AIDS, not to mention organised crime (which is responsible for roughly 60,000 deaths in the past six years). “It could get to the point where we are literally eating ourselves to death,” says Jesper Holland of Novo Nordisk, a Danish health-care company that is a big supplier of insulin to Mexico.
The precise causes of the onslaught are hard to pin down. The prevalence of snacking on salty, fatty food and drinking sugar-heavy fizzy drinks appears to be a big part of the problem. Reforma, a national newspaper, reported on April 9th that fizzy drinks accounted for seven out of ten drinks sold in Mexico. There was a rise of more than 2% last year, despite growing pressure in Congress to slam “sin taxes” upon the drinks. On a per-head basis Mexicans drink more Coca-Cola than any other country.
Lack of exercise—all that traffic means many Mexicans commute for at least two hours a day—is another factor. Though the swanky parts of Mexico City now boast bicycle lanes, parks with exercise machines and graceful boulevards to run along, on the outskirts, where the health problem is gravest, there are few such amenities.
Mr Holland asserts that “economic growth” is a big cause of the illness, especially in developing countries where societies have grown more prosperous in the space of 20 years, compared with hundreds of years in some developed countries. That could be partly true: India and China also have acute diabetes problems. Mexico, however, has not grown faster than other countries in Latin America, and the poor left behind by economic growth are just as likely to snack badly as the more prosperous. What’s more, Mexican-Americans in the United States are almost twice as likely as non-Hispanic whites to be diagnosed with diabetes, which suggests there are powerful genetic factors at work, too.
Perhaps for Mexicans the biggest problem is living next door to the United States, which means the fast food and super-sized culture has a particularly strong influence. So do the American food and drink giants who sell vast quantities south of the border and have already proved adept at fending off sin taxes and other forms of anti-obesity regulation in the United States.
In a country like Mexico where there is not much stigma attached to being overweight, there would probably be stiff opposition to regulating consumers’ behaviour, especially as measures such as higher taxes on soft drinks would fall disproportionately on the poor. Instead, the government should play up gluttony as a killer, as it does with cigarettes—especially in school, where a third of children are said to be obese—and literally scare people off their junk food. Diabetes provides that opportunity. Given Mexico’s extensive public health-care system, the state foots the bill for the sharply rising cost of diabetes treatment. There is huge public interest in giving it more prominence.

Can Mercury in Fish Raise Diabetes Risk?

MONDAY, April 8 (HealthDay News) — Young adults who have higher levels of mercury in their systems may face a 65 percent increased risk of developing type 2 diabetes later in life, a new study warns.
The findings — which are the first to link mercury and diabetes in humans — are alarming in terms of nutrition because eating fish and shellfish is the main source of mercury in people, the researchers added.
They noted that nearly all fish and shellfish contain traces of mercury, but they also contain lean protein and other important nutrients, such as magnesium and omega-3 polyunsaturated fatty acids, which could counter the effects of mercury.
The study included nearly 3,900 men and women between the ages of 20 and 32 who were free of diabetes in 1987 and followed until 2005. Mercury levels in their toenails were measured, and they were tested for diabetes during the study period. The link between mercury levels and type 2 diabetes risk was established after the researchers controlled for a number of lifestyle and dietary factors.
Compared to other participants, the people with the highest levels of mercury had healthier lifestyles (lower levels of body fat, smaller waist sizes and higher levels of exercise) and also ate more fish.
The findings, published recently in the journal Diabetes Care, highlight the need for people to select seafood known to have low levels of mercury, said study leader Ka He, an epidemiologist at the Indiana University School of Public Health.
Types of seafood with lower levels of mercury include shrimp, salmon and catfish, while those with higher levels include swordfish and shark.
Although the study found an association between higher mercury levels and later development of type 2 diabetes, it did not prove a cause-and-effect relationship.

F.D.A. Approves a New Diabetes Drug From J.&J.

The drug, Invokana, will be sold by Johnson & Johnson and treats patients with type 2 diabetes in a new way, by causing blood sugar to be excreted in the urine. Many existing drugs work by affecting the supply or use of insulin.
“We continue to advance innovation with the approval of new drug classes that provide additional treatment options for chronic conditions,” Dr. Mary Parks, who oversees drugs for metabolic diseases at the F.D.A., said in a statement.
Invokana will have a wholesale price of $8.77 per tablet, with one tablet taken daily. Johnson & Johnson said the price was competitive with that of some other diabetes drugs.
Clinical trials of more than 10,000 patients showed that Invokana improved patients’ blood-sugar levels and also led to weight loss and reductions in blood pressure. But the drug, whose generic name is canagliflozin, also has potentially serious side effects. The clinical trials revealed some signs of elevated stroke risk and a small increase in patients’ experiencing heart attacks within the first 30 days of taking the medicine. The drug also was shown to raise LDL, or “bad” cholesterol levels, although it also raised the level of HDL, or “good” cholesterol.
However, an F.D.A. spokeswoman said Friday that the significance of those findings was unclear, and the label of the drug includes no warnings about heart attacks or strokes. The F.D.A. is requiring Johnson & Johnson to conduct five post-marketing studies, including a clinical trial to determine more definitively if the drug increases those risks.
The F.D.A. said the drug’s most common side effects were vaginal yeast infections and urinary tract infections.
In January, an F.D.A. advisory panel voted 10 to 5 in favor of approval. But panel members called on Johnson & Johnson to closely monitor patients enrolled in long-term safety studies. Some of the members said they did not think the drug should be prescribed to people with moderate kidney disease.
The drug wasn’t as effective in such patients, and they were at a higher risk for the negative side effects, compared to people with normal kidney function. Invokana is not recommended for patients with severe kidney disease.
An estimated 26 million Americans have type 2 diabetes, and many of the medications on the market come with side effects like weight gain and hypoglycemia, or a dangerous drop in blood sugar. Patients taking Invokana experienced fewer episodes of hypoglycemia than those taking another diabetes drug, glimepiride, or Amaryl, but a similar number as patients taking the drug sitagliptin, or Januvia.
Invokana is in a class of drugs called SGLT2 inhibitors. They block the action of the sodium-glucose co-transporter 2, which puts sugar removed from the blood by the kidneys back into the bloodstream.
Last year, the Food and Drug Administration rejected another drug in that class, dapagliflozin from Bristol-Myers Squibb and AstraZeneca, because of safety concerns, including a possible increased risk of breast and bladder cancers. But it was approved in Europe in November under the name Forxiga.
Johnson & Johnson is also seeking approval in Europe for Invokana, which it licensed from Japan’s Mitsubishi Tanabe Pharma.
Wall Street analysts have predicted that Invokana could be a good seller for Johnson & Johnson. Lawrence Biegelsen, of Wells Fargo, estimated early this year that the drug could bring in $111 million in 2013, with sales increasing to $667 million by 2016.

Rural to Urban Migration Associated With Increased Obesity and Diabetes Risk in India

May 3, 2010 — Migration from rural to urban areas is associated with increasing levels of obesity and is a factor driving the diabetes epidemic in India, according to a new study published in PLoS Medicine.
 India, like the rest of the world, is experiencing a diabetes epidemic. Diabetes has increased in urban areas of India from 5% to 15% between 1984 and 2004. As in other developing countries this is thought to result from increased consumption of saturated fats and sugar and reduced levels of physical activity. The process of urbanization -- migration from rural areas to towns and cities and the expansion of urban areas into the periphery -- is linked to changes in diet and behaviour. To examine how migration has impacted on obesity and diabetes in India, Shah Ebrahim and colleagues interviewed rural migrants working in urban factories.
The researchers recruited rural-urban migrants working in four factories in central, north and south India and the spouses of these workers if they were living in the same town. Each migrant worker or spouse asked a sibling still living in the rural area that they were originally from to join the study. Non-migrant factory workers and their siblings from urban areas were also recruited. Each participant answered questions about their diet and physical activity and had their blood sugar and body mass index measured.
The results showed similar levels of obesity in urban and migrant men (41.9% and 37.8% respectively), in comparison with 19% of men in rural areas. Diabetes also stood at similar levels in urban and migrant men (13.5% in urban and 14.3% respectively), in comparison with 6.2% in rural men. These patterns of obesity and diabetes were similar in women.
The findings demonstrate that rural-urban migration in India is associated with rapid increases in obesity and diabetes and also indicated that changes in migrant behaviour -- such as reduced physical activity -- put them at similar risk to the urban population. The authors conclude that health promotional activities targeting migrants and their families would help reduce the risk factors for obesity and diabetes and slow the progress of the epidemic.

Inactivity 'No Contributor' to Childhood Obesity Epidemic, New Report Suggests

July 8, 2010 — A new report from the EarlyBird Diabetes Study suggests that physical activity has little if any role to play in the obesity epidemic among children. Obesity is the key factor behind diabetes, heart disease and some cancers.
EarlyBird is based at the Peninsula Medical School in Plymouth, UK, and has been observing in detail a cohort of city school children for the past 11 years.
A review published in 2009 of all trials using physical activity to reduce childhood obesity showed weight loss amounting to just 90g (3oz) over three years, and the EarlyBird study wanted to know why the trials were so ineffective. So they challenged some popular paradigms.
It is well known that less active children are fatter, but that does not mean -- as most people assume it does -- that inactivity leads to fatness. It could equally well be the other way round: that obesity leads to inactivity.
And this is the question EarlyBird was uniquely placed to answer. With data collected annually over several years from a large cohort of children, it could ask the question -- which comes first? Does the physical activity of the child precede changes in fatness over time, or does the fatness of the child precede changes in physical activity over time?
And the answer, published recently in Archives of Disease in Childhood, was clear. Physical activity had no impact on weight change, but weight clearly led to less activity.
The implications are profound for public health policy, because the physical activity of children (crucial to their fitness and well-being) may never improve unless the burgeoning levels of childhood obesity are first checked. If this cannot be achieved through physical activity, the focus has to be on what -- and how much -- children consume.
EarlyBird has already shown how the trajectory leading to obesity is established very early in life, long before children go to school, and how most childhood obesity is associated with obesity in the same-sex parent.
While portion size, calorie-dense snacks and sugary drinks are all important contributors, early feeding errors seem crucial -- and physical activity is not the answer.

Obesity Leads to Decreased Physical Activity Over Time

Mar. 28, 2013 — Physical activity and its relation to obesity has been studied for decades by researchers; however, almost no one has studied the reverse -- obesity's effect on physical activity.
So BYU exercise science professor Larry Tucker decided to look at the other side of the equation to determine if obesity leads to less activity. The findings, no surprise, confirmed what everyone has assumed for years.
"Most people talk about it as if it's a cycle," Tucker said, senior-author on a study appearing online ahead of print in the journal Obesity. "Half of the cycle has been studied almost without limit. This is the first study of its kind, in many ways, looking at obesity leading to decreases in physical activity over time."
To study this reciprocal effect objectively, the researchers attached an accelerometer to more than 250 participants. Accelerometers measure actual movement and intensity of activity. Previous studies have relied on less-dependable self-reported data.
"Roughly 35 percent of the population reports that they're regularly active," Tucker said. "When you actually put an accelerometer on adults and follow them for many days, only about 5 to 7 percent are actually regularly active. We used an objective measure so we could determine genuine movement, not just wishful thinking."
The 254 female participants -- 124 of which were considered obese -- were instructed to wear the accelerometer for seven consecutive days at the beginning of the study, and then again for an additional week 20 months later, at the end of the study.
On average, physical activity in obese participants dropped by 8 percent over the course of 20 months. This is equivalent to decreasing moderate to vigorous physical activity by 28 minutes per week. In contrast, non-obese women demonstrated essentially no change in the amount of physical activity they were participating in weekly.
These results weren't shocking to the researchers, who assumed this study would confirm the destructive cycle; however, it does provide more understanding into how the cycle works and how it can be stopped. It also offers additional insight into the measurement methods researchers use and how self-reporting can yield inaccurate results.
"It's not rocket science, and it's very logical," Tucker said. "It just hasn't been studied using high quality measurement methods and with a large sample size. This provides scientists with more ammunition to understand how inactivity leads to weight gain and weight gain leads to less activity. This cycle, or spiral, is probably continuous over decades of life."
Tucker is a professor and epidemiologist who has conducted many studies on obesity and its contributing factors.
Jared M. Tucker, a graduate student at the time, is the lead author on the paper. Along with Larry Tucker, exercise science professors James LeCheminant and Bruce Bailey were coauthors on the paper.